声门型喉癌垂直部分喉切除,重建方法与效果评价

本文就声门型喉癌１０２例施行垂直部分喉切除的适应症选择、重建方法、术后喉功能恢复及生存率分析。本组拔管率９８．０％（１００／１０２），有良好的发音功能、吞咽功能。３、５、１０年生存率分别为９０．２％、８５．６％、６９．８％。其生存率不亚于全喉切除术。证实垂直部分喉切除术是根治声门型喉癌Ｔ２、Ｔ３期的合理有效的术式。     

声门型喉癌垂直部分喉切除、重建方法与效果评价

本文就声门型喉癌１０２例施行垂直部分喉切除的适应症选择、重建方法、术后喉功能恢复及生存率分析。本组拔管率９８．０％（１００／１０２），有良好的发音功能、吞咽功能。３、５、１０年生存率分别为９０．２％、８５．６％、６９．８％。其生存率不亚于全喉切除术。证实垂直部分喉切除术是根治声门型喉癌Ｔ２、Ｔ３期的合理有效的术式。     

部分喉切除术治疗声门癌的疗效分析

为评价部分喉切除术治疗声门癌的效果，总结１９７４～１９９４年期间治疗声门癌患者１３２例，随访至１９９４年１２月，获得随访资料者１２６例（９５％），进行统计分析。所有病例均经组织病理学证实为喉癌，根据ＴＮＭ分期，Ｔ１、Ｔ２９８例（７７．８％），Ｔ３、Ｔ４２８例（２２．２％）。１例Ｔ４Ｎ１，其他均为Ｎ０。就诊时全部患者均为Ｍ０。１２６例患者均系采用部分喉切除治疗，其中８９例为单纯手术治疗，术前放射治疗４例，术后放射治疗３３例。应用Ｋａｐｌａｎ－Ｍｅｉｅｒ法进行生存率分析，结果１２６例中３年、５年和１０年生存率分别为９４．７％、８９．１％和８６．１％；Ｔ１、Ｔ２组３年、５年和１０年生存率分别为：９７．８％、９５．１％和９３．３％；Ｔ３、Ｔ４组为８３．２％、６２．７％和５２．３％。患者术后均保存了喉的发音功能，能用语言进行社交，喉功能恢复良好。结论：部分喉切除术是治疗声门癌的最佳选择。     

Majer—Piquet手术治疗喉癌的远期疗效分析

目的 探讨Ｍａｊｅｒ－Ｐｉｑｕｅｔ手术治疗声门型喉癌的远期疗效。方法 对１９９０年１０月￣１９９５年２月间手术的３２例病例进行了临床随访。其中Ｔ１Ｎ０Ｎ０２１型，Ｔ１Ｎ１Ｍ０３例，Ｔ２Ｎ０Ｍ０５例，Ｔ２Ｎ１Ｍ０，Ｔ３Ｎ０Ｍ０和Ｔ３Ｎ１Ｍ０各１例。结果 Ｔ１病例的２、３及５年生存率分别为９５．８％，９３．７％和９０．９％，Ｔ２病例的２、３及５年生存率分别为１００％，８３．３％和６０％。拔管率为９６．     

控制血压变化的化学疗法对大鼠颈部移植肿瘤的治疗效果

本文作者应用病理学方法比较了一种新疗法—升降压化学疗法与传统化疗及升压化疗对大鼠颈部移植肿瘤的治疗效果。结果，单纯化疗组动物的肿瘤大小（由０．８±０．２ｃｍ’增至４．３±２．０ｃｍ３）和瘤细胞存活率（７３．５±１９．７％）与无治疗对照组（０．５±０．２ｃｍ３增至６．３±２．４ｃｍ３，８４．７±９．３％）相比禾显著差异；使用血管紧张素Ⅲ（ＡⅡ）的升压化疗组动物的肿瘤（由０．８±０．２ｃｍ３增至２．６±１．９ｃｍ３）比对照组明显缩小（Ｐ＝０．００２），残存瘤细胞的百分率（４９．６±３１．６％）比对照组明显减少（Ｐ＝０．０２６）；而由ＡⅡ升压和硝普钠（ＳＮＰ）降压的升降压化疗组的肿瘤（０．９±０．４ｃｍ３至０．８±０．５ｃｍ３）与单纯化疗和升压化疗两组相比肿瘤显著缩小（Ｐ＝０．００３，Ｐ＝０．０３２），残存瘤细胞百分率（１５．５±１６．６％）比单纯化疗和升压化疗两组显著减少（Ｐ＜０．００１，Ｐ＝０．０３１）。     

HLA—DR在喉癌中的表达及临床意义

应用免疫组织化学方法研究喉癌组织中组织相容性Ⅱ类抗原－ＨＬ－ＤＲ表达情况，９５例患者的喉癌组织中有２９例（３０．５％）ＨＬＡ－ＤＲ阳性，６６例（６９．５％）阴性，而６例喉正常粘膜上皮及６１例癌旁上皮均为阴性，统计分析发现ＨＬＡ－ＤＲ阳性的标本分化程度高者（８２．８％）明显多于ＨＬＡ－ＤＲ阴性者（５６．１％）（Ｐ〈０．０５）前者的５年生存率（７９．６％）略高于后者（７０．５％）但无统计学显著差异（Ｐ     

喉癌术后远期疗效分析

对本院１９８１￣１９９０年间有随访资料的５２例喉癌手术病例进行了术后生存效果分析。本组病例中，男４２例，女１０例；以５０￣５９岁患者居多，占４８．１％；声门上型喉癌２１例，声门型喉癌３１例；多为Ｔ３期病例；喉全切除１７例，喉部分切除３５例。全组病例的３、５、１０年生存率（寿命表法）分别为７７．２％、７２．２％和６３．２％。通过生存期比较，对影响远期疗效的有关因素进行了分析。     

Majer-Piquet手术治疗喉癌的远期疗效分析

目的探讨Ｍａｊｅｒ－Ｐｉｑｕｅｔ手术治疗声门型喉癌的远期疗效。方法对１９９０年１０月～１９９５年２月间手术的３２例病例进行了临床随访。其中Ｔ１Ｎ０Ｍ０２１例，Ｔ１Ｎ１Ｍ０３例，Ｔ２Ｎ０Ｍ０５例，Ｔ２Ｎ１Ｍ０，Ｔ３Ｎ０Ｍ０和Ｔ３Ｎ１Ｍ０各１例。结果Ｔ１病例的２、３及５年生存率分别为９５．８％，９３．７％和９０．９％，Ｔ２病例的２、３及５年生存率分别为１００％，８３．３％和６０％。拔管率为９６．９％。所有患者均经口进食。一经拔管均能发音。其中１９９４年以后手术的８例行改进术式，发音质量较以前有所提高。结论Ｍａｊｅｒ－Ｐｉｑｕｅｔ手术是一种治疗Ｔ１，Ｔ２和部分Ｔ３声门型喉癌有效的术式，而且能较满意地保留喉功能，提高患者的生存质量。     

维甲酸对人喉鳞癌裸鼠移植瘤的治疗观察

目的　寻求有效的喉癌辅助治疗方法,研究全反式（ａｌｌｔｒａｎｓ） 维甲酸（ ｒｅｔｉｎｏｉｃ ａｃｉｄ,ＲＡ）在体内的抗肿瘤作用。方法　利用人喉鳞癌瘤系ＰＨＣ３ 制造裸鼠喉癌模型（ 裸鼠１６ 只, 实验治疗组和对照组各８ 只） ,观察ＲＡ治疗荷喉癌裸鼠的疗效,并在光镜及透射电镜下观察ＲＡ 作用后肿瘤组织显微及超微结构,免疫组化检测肿瘤细胞ｃｍｙｃ 蛋白的阳性率。结果　治疗组肿瘤生长明显受到抑制,抑制率达５０％ 以上（ Ｐ＜ ０．０５）。光镜及透射电镜观察发现,ＲＡ 治疗组裸鼠移植人喉癌细胞有一定程度的良性趋向分化。免疫组化检测肿瘤细胞ｃｍｙｃ 蛋白的阳性率,治疗组（３４．０ ％ ±１０．６％ ） 与对照组（６０．５％ ±１５．２ ％） 相比差异有显著性（ Ｐ＜ ０．０１）。结论　维甲酸对裸鼠移植人喉癌有生长抑制及诱导分化作用,且与ｃｍｙｃ 癌基因及蛋白的调控有关。     

P~(15)蛋白在鼻咽癌中的表达

本实验采用华西医科大学第一附属医院门诊１９９２年上半年获取的５５例鼻咽部低分化鳞癌（ＮＰＣ）的活检存档标本，用１５例正常人鼻咽部组织蜡块作对照。所有标本作免疫组化ＬＳＡＢ法染色，测定Ｐ蛋白的表达。并对所有ＮＰＣ患者进行５年随访。结果表明，Ｐ蛋白在鼻咽部正常组织表达阳性率为１００％，鼻咽部低分化鳞癌阳性率为７０．９％，二者差别有统计学意义（Ｘ２＝４．１３，Ｐ＝０．０４７２）。Ⅰ－Ⅱ期、Ⅲ期和Ⅳ期ＮＰＣＰ蛋白表达阳性率分别为８３．３％、８０．０％、６０．７％，差别有统计学意义（Ｋｗ＝８．３０５０，Ｐ＝０．０４７３）；Ｔ１－Ｔ２、Ｔ３和Ｔ４期ＮＰＣ的Ｐ蛋白表达阳性率分别为８０．８％、７２．２％、４５．５％，差别有统计学意义（Ｋｗ＝１５．３４，Ｐ＝０．０３９４）；无颈淋巴结转移与有颈淋巴结转移组Ｐ蛋白表达阳性率分别为７７．８％、７０．３％，差别无统计学意义（Ｋｗ＝６．２７９３，Ｐ＝０．０５５７）；Ｐ表达阴性组与阳性组的５年生存率分别为：５６．７％、６８．１％，二者差别无统计学意义（Ｐｒ＝０．４７７５）。通过本实验提示：在ＮＰＣ的发生发展过程中有Ｐ１５蛋白丢失的参与；Ｐ１５蛋白表达可作为ＮＰＣ生物学行为的一个参考指标     

喉癌术前放射治疗及单纯手术疗效比较

目的 探讨喉癌术前放射治疗加手术的治疗方式能否比单纯手术提高治愈率。方法 应用前瞻性的随机分组的方法进行临床试验。初治的喉癌病例（不包括声门型Ｔ１病变），年龄在７５岁以下，不伴有喉梗阻，经过临床检查确定解剖分型、ＴＮＭ分期（１９７８ＵＩＣＣ）及手术类型后，通过抽签的方法将患者分入单纯手术组（ＳＡ组）或综合治疗组（ＲＳ组）进行治疗。结果 共完成治疗３７０例，ＳＡ组２１５例，ＲＳ组１５５例，ＳＡ组３年     

喉声门上型低分化鳞状细胞癌57例临床观察

目的 探讨喉声门上型低分化鳞状细胞癌(简称鳞癌)的临床特点、治疗及预后。方法 回顾分析1980～1998年我院57例喉声门上型低分化鳞癌病例(1997年UICC分期：Ⅰ期4例，Ⅱ期5例，Ⅲ期18例，Ⅳ期30例)。单纯手术25例，单纯放射治疗9例，术前放射治疗加手术14例，手术加术后放射治疗7例，术前化学治疗加手术2例。喉全切除23例，喉部分切除25例；同期颈清扫31例(单侧17例，双侧14例)，上颈清扫12例。结果5年生存率47．4％(27／57)，颈部转移率63．2％(36／57)，双颈转移率24．6％(14／57)，远处转移率21．1％(12／57)，局部复发率10．5％(6／57)，颈部复发率28．1％(16／57)，喉部分切除的局部复发率12．0％(3／25)。生存率随分期下降，T1 T2与13 T4和N0 N1与N2 N3的生存率差异分别有显著性(χ^2=4．942，P=0．026；χ^2=4．306，P=0．038)。单纯手术与手术结合放射治疗的生存率差异无显著性，N2和N3患者的手术结合放射治疗相对优于单纯手术。结论 喉声门上型低分化鳞癌患者以晚期病变为主，易较早发生淋巴结转移，颈部转移和远处转移率较高，治疗仍以手术为主，喉部分切除术是可行的，T3病变的喉部分切除和颈部N分级较晚的患者应手术结合放射治疗。     

鼻腔筛窦鳞状细胞癌146例治疗分析

目的 回顾性分析鼻腔筛窦鳞癌不同治疗方案对患者生存率的影响,以期明确影响预后的因素并指导临床治疗.方法 回顾性分析1990-2007年中国医学科学院肿瘤医院头颈外科和头颈放疗科治疗的经病理证实的鼻腔筛窦鳞癌患者146例,其中原发于鼻腔28例,筛窦9例,鼻中隔4例,同时发生于鼻腔筛窦105例.Ⅰ期和Ⅱ期28例,Ⅲ期46例,Ⅳ期72例.术前放疗+手术41例,手术+术后放疗22例,单纯手术5例,单纯放疗78例.采用Kaplan-Meier法和Log-rank检验进行生存分析,多因素分析采用Cox回归模型.结果 146例鼻腔筛窦鳞癌总的5年生存率为49.1%,Ⅰ～Ⅱ期5年生存率为95.7%,Ⅲ期为59.8%,Ⅳ期为28.2%,差异有统计学意义(x2=24.15,P<0.05).术前放疗+手术组、手术+术后放疗组、单纯手术组及单纯放疗组5年生存率分别为57.7%、60.4%、100%和38.8%,各组间生存率差异无统计学意义(P>0.05).单纯放疗组5年生存率38.8%,综合治疗组58.4%(P=0.043).有淋巴转移患者5年生存率为21.3%,而无淋巴转移的为53.7%,差异有统计学意义(x2=12.326,P<0.05).术前放疗+手术组眶内容颅底保留率高于术后放疗和放疗后手术挽救.局部复发和远处转移是死亡的主要原因,92.2%局部复发的病例在3年内发生.Cox多因素分析得出TNM分期和病理分化是主要的预后指标.结论 鼻腔筛窦鳞癌术前放疗+手术或手术+术后放疗的综合治疗方案是有效的治疗方案,早期病例单纯手术可以获得理想的效果.     

Planned preoperative radiation therapy vs. definitive radiotherapy for advanced laryngeal carcinoma

In the period 1970-1980 inclusive, 191 patients with T3T4 laryngeal carcinoma (glottic: 63 and supraglottic: 128) received either definitive radiation therapy (RT) (60-65 Gy in 6-7 weeks) or planned preoperative radiation therapy (25 Gy in 5 equal daily fractions of 5 Gy) followed by laryngectomy with or without neck dissection (RT + S). Selection for RT vs. RT + S was based on medical operability and/or patient's refusal to undergo surgery. All patients are evaluable with minimum of 2 years observation. Crude 5 and 10-year survival probability for 32 patients with glottic localization who received RT is 55% and 38% vs. 65% and 65% respectively for 31 treated with RT + S. For 52 patients with supraglottic site who received RT, the 5 and 10-year survival is 44% and 44% vs. 82% and 60% for 76 patients treated with RT + S.     

山东东部地区女性喉癌患者的临床特点

目的 探讨山东东部地区女性喉癌患者的临床特点。 方法 对22例女性喉癌患者资料进行回顾性分析,其中声门上型8例,声门型13例,声门下型1例;按2002年AJCC标准进行分期：Ⅰ期10例,Ⅱ期2例,Ⅲ期4例,Ⅳ期6例。行喉部分切除术14例,喉全切除术6例,同时行颈清扫术10例,术后放疗10例。单纯放疗2例。生存率采用直接法计算。结果 行手术治疗的20例中,治疗后满3年者11例,失访2例,无瘤生存8例,3年直接生存率72.7%;治疗后满5年者6例,失访1例,无瘤生存5例,5年直接生存率83.3%;行单纯放射治疗的2例分别于治疗后9个月和1年死于复发。结论 女性喉癌发病率较低,声门上型喉癌构成比相对较高,部分女性喉癌患者与吸烟有关,女性喉癌患者的多原发癌值得重视     

108例喉癌手术疗效分析

目的总结喉癌的术式及疗效,以改进治疗并提高喉癌患者的生存率和生存质量。方法分析临床随访的108例行手术治疗的喉癌患者资料,其中声门上型33例,声门型71例,声门下型4例,按UICC2002年分期标准,I期27例,II期42例,III期25例,IV期14例。行喉部分切除83例,全喉切除25例。结果108例手术患者1年生存率94.5%,3年生存率81.3%,5年生存率为75.4%。其中声门上型1年生存率86.3%,3年为65.2%,5年为63.2%;声门型1年生存率98.1%,3年为91.1%,5年为84.2%。早期肿瘤(I、II期)1年生存率100%,3年生存率88.4%,5年生存率84.1%;晚期(III、IV期)肿瘤1年生存率87.2%,3年生存率71.8%,5年生存率59.0%。早期与晚期患者之间生存率差异有统计学意义(P<0.01),肿瘤不同发病部位(声门型、声门上型)患者之间生存率差异有统计学意义(P<0.05)。结论严格掌握喉癌手术指征,在保证手术安全缘的情况下,根据不同患者的情况,制定个体化治疗方案,运用最优的手术切除和喉功能重建方法,综合治疗,可有效地提高喉癌患者的生存率和生存质量。     

Endoscopic CO2 laser therapy of selected cases of supraglottic marginal tumors

Endoscopic CO₂ laser intervention can be used as conservation surgery for supraglottic laryngeal carcinomas in carefully selected patients. We analyzed retrospectively our experience in managing patients with early supraglottic carcinomas operated on at the Clinic of Otorhinolaryngology, Szeged, Hungary, during the 10-year period between 1987 and 1997. Conservation surgery was the treatment of choice in 187 patients, but only 23 (12%) were selected for endoscopic CO₂ laser surgery. Laser surgery was indicated predominantly for T1 cancer of the epiglottis (n = 15), but was also performed for T2 cancers (n = 8). Of the 23 supraglottic tumors treated, 16 had no signs of recurrence to date (1.5 to 9 years after surgery) a local control rate of 70%. Six patients with recurrences underwent salvage therapies that included repeated laser excisions (n = 3), radiotherapy (to 60 Gy), horizontal supraglottic laryngectomy and total laryngectomy. One patient was not resectable because of multiple metastases. Our experience with endolaryngeal CO₂ laser excision indicates that it is a reasonable method in selected cases of supraglottic tumors, but one-third of the patients required salvage treatment. Recieved: 28 September 1998 / Accepted: 15 March 1999     

Exclusive surgery versus postoperative radiotherapy for supraglottic cancer

AIM OF THE STUDY: To verify the effectiveness of prophylactic postoperative radiotherapy for supraglottic cancer. PATIENTS AND METHODS: 97 patients underwent supraglottic horizontal laryngectomy with bilateral neck dissection: 35 patients (group A) received postoperative radiotherapy (60-70 Gy, 2 Gy fractions daily); 62 patients (group B) received only surgery. RESULTS: Overall 5-year actuarial survival and corrected actuarial survival rates were 74 and 90% in group A and 61 and 80% in group B (p = 0.2 and 0.4, respectively). As for tumor extent, no significant differences were observed between the two groups. In N0 patients overall actuarial survival rate was significantly higher in group A as compared to group B (p = 0.01); most likely this difference was due to errors in clinical staging for the presence of reactive lymphadenitis and micrometastases. CONCLUSIONS: The present study did not document the effectiveness of postoperative radiotherapy. Radiation therapy should be avoided in those patients in whom surgery was proven to be curative while it could be considered in combination with surgery when the resection margins are dubious and/or inadequate.     

Conservation surgery for T2 and T3 carcinomas of the supraglottic larynx

The treatment of choice for supraglottic carcinomas of intermediate size (stages T2 and T3) remains controversial. Between 1974 and 1983 in our institution, 139 patients with supraglottic carcinoma of intermediate size were judged retrospectively to have been technically amenable to conservation surgery. Primary disease control at three years was achieved in 100% of the patients treated by supraglottic laryngectomy, 91% (34 patients) of those treated by total laryngectomy, and 69% (81 patients) of those treated by radiotherapy. Of the latter group, 62% were salvaged by total laryngectomy yielding a net three-year local control of 85%. Determinate five-year survival rates were 89% for supraglottic laryngectomy, 78% for total laryngectomy, and 70% for radiotherapy. Significant problems with aspiration occurred in four patients (16%) who were treated by conservation surgery, and two patients (8%) required a permanent tracheostomy. The results of this study show that supraglottic laryngectomy with postoperative radiotherapy as indicated is a highly effective method for the local control of supraglottic carcinoma of intermediate size that is amenable to conservation surgery.     

The management of laryngeal cancer.

Carcinoma of the larynx is best managed in an interdisciplinary centre with wide therapeutic and rehabilitative services. Current management is confused, but may be simplified by consideration of three groups: 1) no fixation of laryngeal structures, 2) fixation of laryngeal structures and extension beyond the larynx, 3) all others including carcinoma in situ, verrucous carcinoma, transglottic tumor, and squamous carcinoma with marked airway obstruction. The rational treatment of Group 1 glottic tumors is primary radiation, which produces 75% crude and 92% corrected five year tumor free survival. If surgery is undertaken as primary treatment or for salvage, a vertical hemilaryngectomy may preserve the voice. Group 1 supraglottic carcinomas may be divided into supraglottic and marginal. Thirty per cent have palpable nodes at diagnosis and a further 20% occult disease in the cervical chain. Irradiation of neck nodes or block dissection is an integral part of treatment. The indications for a supraglottic horizontal partial laryngectomy are outlined. Where indicated this has five year survival figures of 70%. Recurrence is usually in the neck. Marginal tumors have a 50% five year survival rate when treated by conservation surgery combined with pre-operative radiation. Recent radiotherapeutic advances have improved treatment of these lesions. Thirty to 40% of patients with Group 2 tumors have regional metastases at presentation. There are no fixed protocols for treatment of these patients, less than 50% of whom will survive five years tumor free. The difficulty in carrying out a protocol based on pre-operative radiation with planned surgery is outlined. Under optimum conditions treatment should be primary radiation with salvage surgery for failures or recurrence, for the results are almost as good as primary surgery but 30% of larynges are saved. The difficulties of diagnosing recurrent tumor in irradiated tissue are discussed. Care must be taken to recognize that group of patients in whom tissue edema is the result of perichondritis rather than tumor recurrence, because in these patients surgery is extremely hazardous. Problems of diagnosis and methods of treatment of carcinoma in situ, and verrucous carcinoma are described. Transglottic carcinomas are defined and treatment is primary total laryngectomy with appropriate neck dissection. Similarly if tumors are causing major airway obstruction, treatment is by primary laryngectomy.